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The burden of malnutrition across the world remains unacceptably high, and progress unacceptably slow. However, although the world is off track, the chance to end malnutrition has never been greater. These are the messages of the “2018 Global Nutrition Report” released in Bangkok on 29 November. The comprehensive report on nutrition, written by an expert group, reviews existing processes, highlights progress in combating malnutrition, identifies challenges and proposes ways to solve them. According to the report, stunting declined from 32.6% of all the world’s children under 5 years of age in 2000 to 22.2% in 2017. In numbers, this is a decline from 198.4 million to 150.8 million children. Stunting among children in Africa has decreased in percentage terms from 38.3% to 30.3% over the same period. However, due to population growth, the actual number of stunted children has risen. There has been a slight decrease in underweight women since 2000, from 11.6% to 9.7% in 2016. Yet, while there has been progress, it has been slow and patchy.

On the other hand, overweight and obesity among adults are at record levels with 38.9% of adults overweight or obese, stretching from Africa to North America, and increasing among adolescents. Women have a higher prevalence of obesity than men, at 15.1% compared with 11.1%. Worldwide, 38.3 million children under five years are overweight. Beyond health, slow progress on malnutrition is also impacting the social and economic development of countries. It is estimated that malnutrition in all its forms could cost society up to US$3.5 trillion per year, with overweight and obesity alone costing US$500 billion per year. “The figures call for immediate action. Malnutrition is responsible for more ill-health than any other cause,” said Corinna Hawkes, co-chair of the report and Director of the Centre for Food Policy. “The health consequences of overweight and obesity contribute to an estimated four million deaths, while undernutrition explains around 45% of deaths among children under five.”

The assessment shows that just under 50% of countries are on course to meet at least one of nine global nutrition targets. However, no country is on track to meet all of the nine targets that are being covered in the report and just five countries are on track to meet four. Not a single country is on course to meet the adult obesity target. “The uncomfortable question is not so much ‘why are things so bad?’ but ‘why are things not better when we know so much more than before?’” said Hawkes. The report highlights that solutions already exist but the bad news is that effective ideas are not being adopted at scale. For example, studies show that sugar-sweetened beverage taxes are working effectively to reduce consumption of unhealthy drinks. In Mexico, an evaluation of the sugar-sweetened beverage tax found that sales of targeted beverages fell by 9.7% across the population two years after the policy was implemented. The greatest decline in purchases (17%) was seen among households of lower socioeconomic position. Similar studies in Chile and the US (Berkeley and Philadelphia) have also demonstrated the desired policy effect. “While malnutrition is holding back human development everywhere, costing billions of dollars a year, we are now in a position to fight it,” said Jessica Fanzo, co-chair of the report. “From policies such as sugar taxes, to new data that enables us to understand what people are eating and how we can best target interventions, the global community now has the recipes that work.”

The authors call for better political commitment to end malnutrition in all its forms. They mention new nutrition policies developed in China as an example. The country is facing the second-largest undernourished population, with overweight and obesity levels rising at alarming rates and diet-related non-communicable diseases (NCDs) such as diabetes on the up. To address this, China developed two plans with the potential to transform malnutrition. The National Nutrition Plan (2017–2030), released last year, includes a range of malnutrition targets including stunting, obesity, anaemia, breastfeeding and folic acid deficiency among vulnerable people. Among the measures of the plan are nutrition monitoring, new dietary reference intakes, screening programmes, a campaign to promote healthy lifestyles, recommended limits for sugars, fats and salt in packaged foods, nutrition labelling in cafes and restaurants, standards on fortified foods, and education on healthy diets. It recommends a balanced diet combining cereals, meat, vegetables, fruit, milk and soy. (ab)